Mechanocardiographic effects of an elevated central venous pressure.

Since 1985 we demonstrated that the increase of left ventricular mean diastolic pressure shortens the interval existing between the onset of the electrocardiographic P-wave and the onset of the left apexcardiographic "a"-wave (Aubert et al., 1981; Mortarino et al., 1985). In particular we showed that left P-"a" time interval shortens below 100 msec when left ventricular mean diastolic pressure rises above 12 mmHg. Our results thus substantiated the previous reports related to the P-4th heart sound shortening and 4th heart sound--1st heart sound increase occurring in patients with left ventricular failure (Shapira et al., 1982). In that same period, Kesteloot and collaborators showed a direct relationship between the velocity of appearance of the right internal jugular pulse (JVP) waves and the value of central venous pressure (CVP) (Minten et al., 1985). Moreover the range of variability of the right P-"a" interval (which is the time elapsing between the onset of the electrocardiographic P-wave and the onset of the "a"-wave on the JVP tracing) is, in adult subjects, of similar magnitude of the left P-"a" interval (respectively 60-140 msec (Fishleder, 1968) and 80-160 msec (Mortarino et al., 1985) suggesting a symmetric effect of an elevation of diastolic pressure on left and right P-"a" intervals. We therefore decided to test this hypothesis in a group of patients.

Cardiovascular pressor reactivity after chronic converting enzyme inhibition.

In addition to inhibiting the formation of angiotensin II, chronic converting enzyme inhibition may affect other blood pressure modulating factors. The influence of an 8 week treatment phase with cilazapril on the activity of the renin-angiotensin-aldosterone and sympathetic nervous systems, the pressor reactivity to infused angiotensin II or norepinephrine, the chronotropic response to isoproterenol, and body sodium and plasma atrial natriuretic peptide concentrations was assessed in 11 normal subjects and 12 patients with essential hypertension. As compared to a 4 week placebo phase, cilazapril decreased arterial pressure in both study groups (from 124/83 +/- 9/6 to 114/77 +/- 9/5 mm Hg and from 143/102 +/- 13/7 to 137/96 +/- 10/10 mm Hg; P less than .025); exchangeable sodium (-158 mmol and, respectively, -104 mmol) and upright plasma aldosterone (-24% and -15%) also tended to fall. Heart rate, the chronotropic response to posture or isoproterenol, plasma norepinephrine levels, the concentration/pressor response curve to norepinephrine, plasma atrial natriuretic peptide concentration, plasma angiotensin II and the responses of blood pressure or plasma aldosterone to angiotensin II were unchanged after 8 weeks of cilazapril. Plasma renin activity increased (+175% to +650%). These findings indicate that the blood pressure lowering effect of cilazapril in the stable phase of pharmacological intervention is not associated with modifications of sympathetic-dependent pressor reactivity or beta-adrenergic sensitivity. Plasma angiotensin II concentration and angiotensin II-dependent pathways including the pressor and aldosterone responsiveness to angiotensin II are also unchanged.

Mechanocardiographic effects of ACE-inhibitors.

Twenty-one subjects who suffered a recent medium sized anterior myocardial infarction conditioning a mild congestive heart failure were randomly allocated to treatment with captopril (25 mg b.i.d., 10 pts) or placebo (11 pts). After 2 months of therapy the group on the active treatment showed a significant increase of apexcardiographic protodiastolic filling period duration reflecting a clear cut decrease of mean pulmonary capillary wedge pressure (from 14 +/- 2 to 7 +/- 3 mm Hg) while patients on placebo did not show any difference in respect to baseline. Neither treatment significantly modified the PEP/LVET ratio despite a significant increase of left ventricular ejection fraction in patients receiving captopril (from 37 +/- 4% to 43 +/- 5%). Cardiac response to ACE-inhibitors can thus be noninvasively monitored by apexcardiography.

[Clinical and radiological diagnosis considerations on 2 cases of achalasia]. / Considerazioni cliniche e di diagnostica radiologica su due casi di acalasia.

Two cases of achalasia of the lower third of the oesophagus are presented. Leucoplakia was encountered in one of the cases. The clinical, aetiopathogenic and x-ray diagnostic aspects of achalasia are described in relation to the possibility that it may be associated with neoplasia or pre-cancerous alterations. In both the above cases, early dysphagia was encountered.

[Radiographic diagnosis in the early recognition and evaluation of incapacitating sequelae of advanced rheumatoid arthritis]. / Diagnostica radiografica nella diagnosi precoce e nella valutazione dei postumi invalidanti di artrite reumatoide avanzata.

Two observed cases of rheumatoid arthritis, one at an initial, the other at a very advanced stage, form the basis for a detailed report on the radiographic signs of the disease. Particular emphasis is placed on the possibilities offered by the various radiographic techniques for the evaluation of the sequelae of rheumatoid arthritis and for the early diagnosis of the disease.